MODULE 22 SOLVE.

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discussion.

Now, you might be thinking "the boys are getting a bit existentialist with this solve". We assure you, we're not. Paediatrics is a daunting field - it is a specialty after all. So, how do you learn it all for the exam in a couple of modules? The answer is by thinking about what's really high yield.

It's also worth remembering that each of you will have quite a lot of practical paediatric experience - after all it is a requirement of your training to keep a log book. So, a lot of the exam related paeds stuff, particularly the practical stuff, you should already know. As always, when you are thinking about a question in the exam, try to picture the patient in front of you. If you would not normally drip the child, don't feel compelled to put in a central line just because it's the exam.

With that in mind let's look at the topics of the most recent 19 paediatric questions up until the change of exams:

Fever and assessment

Assessment of paediatric head injury

Fever and assessment of the neonate

Measles v Kawasaki

Management of Ptx and LRTI

Fever and investigation

Assessment of a vomiting child

Paediatric gastroenteritis

Assessment of the jaundiced neonate

Assessment and investigation of fever in a neonate

Nasal foreign body

Management of burns

Assessment of abdominal pain

Assessment of a vomiting neonate

Nasal foreign body

Assessment of the crying baby

Management of anaphylaxis

Management of status epilepticus/parent

Management of asthma

So, we think there are some definite themes to this list.

The first is that there are several “manage a specific medical condition” type questions:

Asthma

DKA

PTx and pneumonia

Anaphylaxis

Status epilepticus

Burns

Now, we are going to go out on a limb and say that these are paediatric “free hits”. That is, if you can say something sensible about managing these topics in adults, you must be able to say something sensible in kids – the management is effectively the same (you just need to put in the weight specific doses). So, you cover about a quarter of the list of paediatric topics just by knowing the stuff you have already studied well, with no additional effort. Awesome.

This brings us back to what is different about paediatrics.

There are two things.

The first is the assessment of a child – you can’t do it the same way you do in an adult, and important parts of the history are different. The differentials also change a bit for some conditions (most notably abdominal pain).

What are you going to be asked to assess?

Take a look at the list above, and it’s pretty obvious:

Febrile children (having an expert knowledge of this topic is a *must*)

Abdominal pain

(It hasn’t come up on the list but we’d add “sore hip”)

Head injury

These are all high yield paediatric topics, and so being able to put together a sensible assessment type answer is important. What are the components of an assessment you need to be able to write about?

The second thing to thing about is specific paediatric issues that require management, and again, the list is not that big:

Managing the parents

NAI

Specific paediatric medical problems:

Measles/Kawasaki/other rashes

Head injury

Transient synovitis

Neonatal jaundice

Rehydrating a child with gastroenteritis

Now, our list is not exhaustive. We are happy to hear comments and suggestions via the VSG. The point we are trying to make this week is before you get lost in Cameron’s paediatric emergency medicine, think about what you really need to know. The links we have listed in the read section to the NSW Health Guidelines for Paediatrics in ED are really useful for reading about both the underlying basis for why we do what we do with common paediatric presentations, and for clinically focused reading that should translate to the exam.